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Development of a universal thoracic enhanced recover after surgery protocol for implementation across a diverse multi-hospital health system.
| Content Provider | Europe PMC |
|---|---|
| Author | Dyas, Adam R. Kelleher, Alyson D. Erickson, Crystal J. Voss, Jennifer A. Cumbler, Ethan U. Lambert-Kerzner, Anne Vizena, Annette S. Robinson-Chavez, Celisse Kee, Brandi L. Barker, Alison R. Fuller, Melissa S. Miller, Susan A. McCabe, Katherine O. Cook, Katharine M. Randhawa, Simran K. Mitchell, John D. Meguid, Robert A. |
| Copyright Year | 2022 |
| Abstract | BackgroundImplementation of enhanced recovery after surgery (ERAS) pathways for patients undergoing anatomic lung resection have been reported at individual institutions. We hypothesized that an ERAS pathway can be successfully implemented across a large healthcare system including different types of hospital settings (academic, academic-affiliated, community).MethodsAn expert panel with representation from each hospital within a healthcare system was convened to establish a thoracic ERAS pathway for patients undergoing anatomic lung resection and to develop tools and analytics to ensure consistent application. The protocol was translated into an order set and pathway within the electronic health record (EHR). Iterative implementation was performed with recording of the processes involved. Barriers and facilitators to implementation were recorded.ResultsDevelopment and implementation of the protocol took 13 months from conception to rollout. Considerable change management was needed for consensus and incorporation into practice. Facilitators of change included peer accountability, incorporating ERAS care elements into the EHR, and conducting case reviews with timely feedback on protocol deviations. Barriers included institutional cultural differences, agreement in defining mindful deviation from the ERAS protocol, lack of access to specific coded data, and resource scarcity caused by the COVID-19 pandemic. Support from the hospital system’s executive leadership and institutional commitment to quality improvement helped overcome barriers and maintain momentum.ConclusionsDevelopment and implementation of a health-system wide thoracic ERAS protocol for anatomic lung resections across a six-hospital health system requires a multidisciplinary team approach. Barriers can be overcome though multidisciplinary team engagement and executive leadership support. |
| ISSN | 20721439 |
| Journal | Journal of Thoracic Disease |
| Volume Number | 14 |
| PubMed Central reference number | PMC9442517 |
| Issue Number | 8 |
| PubMed reference number | 36071784 |
| e-ISSN | 20776624 |
| DOI | 10.21037/jtd-22-518 |
| Language | English |
| Publisher | AME Publishing Company |
| Publisher Date | 2022-08-01 |
| Access Restriction | Open |
| Rights License | Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0. 2022 Journal of Thoracic Disease. All rights reserved. |
| Subject Keyword | Thoracic enhanced recovery after surgery (thoracic ERAS) enhanced recovery after surgery (ERAS) dissemination and implementation |
| Content Type | Text |
| Resource Type | Article |
| Subject | Pulmonary and Respiratory Medicine |
